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NCT Number: NCT07643103

Immuno-Targeted Therapy Plus Low-Dose Chemotherapy for Newly Diagnosed Adult Ph-Negative B-ALL: A Prospective Umbrella Trial

This is a prospective, open-label, single-arm, umbrella phase 2 clinical trial enrolling 32 adult patients with newly diagnosed Philadelphia chromosome-negative (Ph-) B-cell acute lymphoblastic leukemia (B-ALL). All patients receive a frontline treatment backbone consisting of low-dose chemotherapy combined with immuno-targeted agents and a BCL2 inhibitor. Subsequent treatment pathways are guided by MRD response, disease characteristics, and clinical decision-making, including antibody-based immunotherapy, CAR-T cell therapy, or hematopoietic stem cell transplantation. All patients continue protocol-defined maintenance therapy after consolidation.

The primary endpoint is the complete remission rate with negative flow cytometric MRD after induction therapy. MRD is monitored longitudinally by flow cytometry, quantitative PCR, and immune repertoire sequencing. Safety is evaluated according to NCI CTCAE version 5.0.

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Key information

Conditions

Ph- Acute Lymphoblastic Leukemia (Ph-ALL)

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 2

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Newly diagnosed adult (≥18 years) patients with Ph-negative B-cell acute lymphoblastic leukemia according to WHO 2022 criteria.
  • CD22-positive expression on tumor cells (CD22 ≥20%).
  • Expected survival ≥3 months.
  • Sexually active men and women of childbearing potential must agree to use effective contraception.
  • Ability to understand and voluntarily sign informed consent, and willingness to comply with study requirements. Informed consent must be signed by the patient or a legal next of kin prior to initiation of any study-specific procedures.

Exclusion criteria

  • Burkitt lymphoma/leukemia.
  • Acute leukemia of ambiguous lineage.
  • Pregnant women.
  • Severe, uncontrolled active infections.
  • History of chronic liver disease (e.g., liver cirrhosis) or prior veno-occlusive disease (VOD) / sinusoidal obstruction syndrome (SOS).
  • History of clinically significant ventricular arrhythmias, unexplained syncope (not vasovagal), or sinus node dysfunction or high-grade atrioventricular (AV) block with chronic bradycardia, unless a permanent pacemaker has been implanted.
  • Uncontrolled active hepatitis B or hepatitis C infection, or known HIV seropositivity. HIV testing may be required according to local regulations or standards.
  • Psychiatric disorders that may impair the subject's ability to complete treatment or provide informed consent.
  • Any other conditions deemed by the investigator to render the subject unsuitable for participation in the study.

Treatment and study plan

Inotuzumab Ozogamicin (IO)

Drug

Anti-CD22 antibody-drug conjugate (ADC) administered intravenously during induction and consolidation therapy.

Venetoclax

Drug

BCL-2 inhibitor administered orally daily during induction and consolidation cycles to enhance leukemic cell apoptosis.

Blinatumomab

Drug

CD19/CD3 bispecific T-cell engager (BiTE) administered as continuous intravenous infusion during consolidation therapy.

CD19-directed chimeric antigen receptor (CAR-T) T cells

Biological

Autologous CD19 CAR-T cell therapy administered as a single intravenous infusion as optional consolidation therapy for eligible patients.

Vincristine

Drug

A vinca alkaloid that inhibits microtubule formation by binding to tubulin, resulting in mitotic arrest and inhibition of proliferation of rapidly dividing leukemic cells.

Cyclophosphamide

Drug

An alkylating agent that forms DNA cross-links, leading to inhibition of DNA replication and transcription and subsequent apoptosis of rapidly proliferating hematopoietic cells.

Dexamethasone

Drug

A synthetic glucocorticoid that induces lymphoid cell apoptosis and exerts anti-inflammatory and immunosuppressive effects, contributing to reduction of leukemic burden.

methotrexate

Drug

A folate antimetabolite that inhibits dihydrofolate reductase, resulting in impaired DNA synthesis and cell replication, particularly in rapidly dividing lymphoid cells.

Cytarabine (ARA-C)

Drug

A pyrimidine nucleoside analog that inhibits DNA polymerase, leading to termination of DNA chain elongation and inhibition of leukemic cell proliferation.

Prednisone

Drug

A glucocorticoid that induces apoptosis in lymphoid cells and provides anti-inflammatory and immunosuppressive effects as part of multi-agent leukemia therapy.

Mercaptopurine 50 mg

Drug

A purine analog antimetabolite that interferes with purine nucleotide synthesis and incorporates into DNA and RNA, inhibiting nucleic acid synthesis and cell proliferation.

Primary outcomes

  1. Flow Cytometric MRD-Negative Complete Remission Rate

    Time frame: At the end of induction therapy (approximately 1 month after treatment initiation)

    Proportion of patients achieving complete remission (CR) with negative measurable residual disease (MRD) assessed by multiparameter flow cytometry after completion of induction therapy.

Secondary outcomes

  1. Next-Generation Sequencing (NGS)-MRD Negative Remission Rate

    Time frame: Within 3 months after treatment initiation

    Proportion of patients achieving MRD-negative remission assessed by immune repertoire sequencing.

  2. Best MRD Clearance Rate

    Time frame: Within 3 months after treatment initiation

    Proportion of patients achieving the deepest MRD response during the first 3 months of treatment as assessed by flow cytometry, quantitative PCR, or immune repertoire sequencing.

  3. Overall Survival (OS)

    Time frame: Up to 5 years

    Time from study enrollment to death from any cause.

  4. Disease-Free Survival (DFS)

    Time frame: Up to 5 years

    Time from achievement of complete remission to relapse or death from any cause.

  5. Relapse-Free Survival (RFS)

    Time frame: Up to 5 years

    Time from achievement of MRD-negative remission to hematologic relapse or death.

  6. 30-Day Mortality

    Time frame: 30 days

    Proportion of patients who die from any cause within 30 days after treatment initiation.

  7. 60-Day Mortality

    Time frame: 60 days

    Proportion of patients who die from any cause within 60 days after treatment initiation.

  8. Incidence of Adverse Events

    Time frame: From treatment initiation through completion of study treatment, up to 5 years

    Frequency, severity, and type of adverse events graded according to the National Cancer

Study contacts

Contact information is provided by the study sponsor or research team.

Ying Wang, MD, PhD

CONTACT

[email protected]

+86 22-23608095

Sponsors and collaborators

Lead sponsor

Institute of Hematology & Blood Diseases Hospital, China

Other

Registry information

Official study title

A Prospective Umbrella Clinical Trial of Immuno-Targeted Agents Combined With Low-Dose Chemotherapy for Newly Diagnosed Adult Philadelphia Chromosome-Negative B-Cell Acute Lymphoblastic Leukemia

Acronym: Ph- ALL-2026

Important dates

Study start
2026
Primary completion
2028
Study completion
2030
First posted
Jun 11, 2026
Registry last updated
Jun 11, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.